Job Summary

Pay Range : $47,500- $88,000

Note : Individuals typically begin between the minimum to middle of the pay range

The Federal Employee Program (FEP) Business Specialist is responsible for administering the Blue Cross Blue Shield Service Benefit Plan, a part of the Federal Employee Health Benefits Program (FEHBP).

The FEP Business Specialist, with guidance from the FEP Supervisor, will assist with all aspects of the program administration and performance of FEP as set forth by the Office of Personnel Management (OPM) and Blue Cross Blue Shield Association Federal Employee Program Director's Office (FEPDO) in alignment with corporate and divisional strategiesand plans.

Program administration includes, but is not limited, to planning, coordinating, testing, and implementing projects related to the enhancement, improvement, and / or modification of customer servicing and claims processing operations, benefits administration, quality improvement engagements, and integrated health management services.

The ideal candidate will also represent FEP on corporate initiatives and ensure compliance with federal, state, and other regulatory requirements.

Minimum Qualifications

• Bachelor's degree and one year of related work experience; or an equivalent combination of education and related work experience.
• Excellent verbal and written communication skills and the ability to write high-level communications for specific audiences
• Knowledge of project management methods, utilization management activities, accreditation standards
• Advanced command of English and grammar rules
• Excellent organizational skills and ability to work independently
• Excellent knowledge of FEP products and processes
• Excellent customer service skills
• Excellent interpersonal and collaboration skills
• Intermediate working knowledge of Microsoft Office applications, includes Outlook, Word, and Excel

Duties and Responsibilities

• Support day-to-day business operations and functions. This includes processing claims, member / provider servicing (both in-person and telephonically), identifying trends in operational efficiencies, researching inquiry escalations, and responding to secure messages, written correspondence, and refunds.
• Support cross functional teams (including but not limited to HMSA staff and external partners and providers) to collect, communicate and distribute information and conduct quantitative / qualitative analysis to identify areas of opportunity and make recommendations for department / corporate action to support FEP Plan Incentive Program (PIP) metrics.
• Develop methods to improve daily customer service and claims processing operations and practice standards. This includes, but is not limited to, analyzing business problems, enhancements to add functionality and / or redesign of systems to improve efficiencies, conducting training, documenting policies, procedures and workflows, trend and reflect impact of activities.
• Monitor, evaluate, educate and implement FEP program requirements related to Utilization Management (UM), Case Management (CM), Medical Management (MM), and Disease Management (DM) activities to areas within the department for appropriate action.

This includes tracking daily operations to ensure deliverables are met and reporting information to FEP Director's Office, various internal committees and other audiences as needed.

Support compliance reviews and audits to monitor adherence with federal and state regulations, FEPDO program rules, Office of Personnel Management (OPM) regulatory guidance, and internal policies and procedures.

Ensure that "best practices" are implemented, and observations / findings are satisfactorily resolved.

Identify and protect FEP assets through a detailed analysis, review, and evaluation of Fraud, Waste, and Abuse (FWA) methodology and best practices consistent with HMSA's FWA program.

This includes taking a proactive role in identifying, digesting, and communicating trends and assisting in the coordination of resolution for these trends.

Last updated : 2024-06-22